| NPI | 1376930537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.131099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.131099) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2020-08-20 |